My experience at ‘The Global Research Collaborative Meeting on Menstrual Health’ at WHO, Geneva

Guest post by Aditi Sharma, Women Deliver 2016 Young Leader. Image: WHO

On 23rd -24th August, 2018, the World Health Organization (WHO) convened a Global Research Collaborative Meeting on Menstrual Health.

This was a first initiative by WHO to include menstrual health and hygiene in its agenda in a systematic manner. The aim of the two-day technical workshop was to review the recommendations from the Gender Advisory Panel (GAP) on developing a portfolio of work in the area of menarche, menstruation, menstrual hygiene and menstrual health; and to define RHR/HRP’s work in this area, in line with WHO’s comparative advantage and considering the work of others and our readings of the current gaps in the field. Experts from all around the world working in the field of menstrual health were invited. Two young leaders were also invited to be a part of this meeting. As a Women Deliver Young Leader working in this field for the last seven years, I was one of them.

Coming from Nepal, I have witnessed menstrual hygiene to be a topic of shame and stigma all my life.

Menstruating women and girls are often restricted to enter the kitchen or temples. Having born and brought up in the city, I naively believed that those unfair restrictions were the extent of the stigma. It was during my visit to the far west Nepal that I first witnessed a girl barely in her teens, cooped up in a shed as if she were a domesticated animal. She was menstruating at that time, and hence was banished to sheds as part of the Chhaupadi tradition. Chhaupadi is a tradition of banishing women and adolescent girls, during their menstruation period, by barring them from entering the homes and instead relegating them to the cowsheds and sties as they are considered impure and untouchable.

This inhumane and heartless practice continues even today in the lives of tens of thousands of helpless females as they go about their regular natural period cycles. Since that trip, it has been my mission to promote menstrual health and fight against the stigma attached to it.

In an effort to advocate for menstrual health, I co-founded an NGO called Kalyani to address the neglected need to raise awareness about menstruation, promote safe hygienic menstrual practices and fight social taboos related to menstruation. As a fierce and tireless advocate for menstrual health, I was honored to be recognized a young expert in this field by WHO.

During the meeting six key thematic areas were identified:

  1. awareness and understanding & stigma, norms and socio-cultural practices
  2. menstrual products & standardization
  3. access to water and functional toilets & disposal
  4. empathy and support during menstruation & clinical care
  5. consequences of lack of awareness/ understanding, stigma & hygiene, care and support
  6. integration with other programmes & financing

Given my experience, I was asked to present on the topic ‘Stigma, norms and socio-cultural practices’.

Image: Aditi Sharma

Here is a synopsis of my presentation in line with the analytical framework provided: What is the current situation and what factors contribute to the situation?

Menstruation is a topic of stigma around the world perpetuated by cultural taboos and silence, mostly prominent in developing countries. From self-policing and coping in silence to culturally restrictive practices, the factors that contribute to the situation are lack of awareness and education on menstruation that further perpetuates myths, lack of hardware such as sanitary products, gender-sensitive toilets and proper disposal, lack of social support, women’s lower status in society and gender stereotypes along with media portrayal and negative stereotypes about PMS. Negative impact on women’s health, sexuality, well-being and social status. The embarrassment, shame and stigma hinders development of adequate solutions for ensuring good menstrual hygiene practices. Hence, MHM receives limited attention in policies, research priorities, programs and resource allocation.

Where do we want to be in ten years?

In ten years, menstruation should no longer be a taboo. It should be presented as a normal and natural occurrence and should be perceived positively. Women and girls should have access to necessary information and materials required to maintain their menstruation hygienically and with dignity. Appropriate information on menstruation should be provided to girls before they reach menarche and then throughout their menstruating years.

What actions will it take to get there?

Creating an enabling environment by raising awareness that is tailored to local and cultural context and community based focusing beyond girls, promoting adequate hygiene, ensuring access to affordable and sustainable products and gender-sensitive toilets with proper disposal
would be an important action to get there. It should be a process that ensures participation of women and girls to respond to their needs
and preferences. It is very important to strengthen their voices and agency.

As most of these stigmas stem from patriarchal norms, involving men and boys is essential.

There is a need to change their attitudes about menstruation through better awareness and information. As culture is not a static concept, harmful cultural practices need to change which is possible through healthy and open dialogue on the roots of these beliefs and their negative
consequences.

What facts and figures do we need to move this agenda forward?

There is a need for greater research in the field of menstrual health overall, but more so on stigmas surrounding menstruation. More research on the perception on menstruation and the roots of stigma is necessary. A lot of interventions have been introduced to fight these stigma
and promote menstrual health. More action research is needed to understand the effectiveness of these interventions in terms of what worked (and why) and what didn’t (and why).

Menstrual health is already a topic that receives less funding, hence, we need more research to understand how to make effective use of scarce resources.

What special contribution could WHO make?

As a trusted organization, WHO can develop and disseminate standardized guidelines for menstrual health with strategies of adaptation and implementation in national and local levels in terms of education, sanitary products, gender-sensitive toilets and disposal. Officially including menstruation in WHO’s agenda will stimulate more support to give menstrual hygiene greater priority for governments and international organizations and donors.

Moreover, removal of stigma around MH can create an environment for discussing and dealing openly with other stigmas attached to other critical health issues.

 

A full report of this meeting is currently being prepared and will be released shortly with details on the discussions on all the thematic areas.

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About the guest blogger:

Aditi is currently a Doctor of Public Health (DrPH) student at the Penn State College of Medicine in Hershey, Pennsylvania. She is a fierce advocate for women’s health, especially menstrual health and hygiene. In 2014, Aditi founded Kalyani with peers who are also dedicated to improving the lives of women in Nepal. This NGO works to empower women through promoting and advocating for menstrual hygiene management.